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Human coronavirus circulation in the United States 2014-2017.

rocky
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Human coronavirus circulation in the United States 2014-2017. Empty Human coronavirus circulation in the United States 2014-2017.

Post by rocky on Wed 01 Apr 2020, 2:56 am

J Clin Virol.  2018 Apr;101:52-56. doi: 10.1016/j.jcv.2018.01.019. Epub 2018 Jan 31.
Human coronavirus circulation in the United States 2014-2017.
[url=https://www.ncbi.nlm.nih.gov/pubmed/?term=Killerby ME[Author]&cauthor=true&cauthor_uid=29427907]Killerby ME[/url]1, [url=https://www.ncbi.nlm.nih.gov/pubmed/?term=Biggs HM[Author]&cauthor=true&cauthor_uid=29427907]Biggs HM[/url]2, [url=https://www.ncbi.nlm.nih.gov/pubmed/?term=Haynes A[Author]&cauthor=true&cauthor_uid=29427907]Haynes A[/url]3, [url=https://www.ncbi.nlm.nih.gov/pubmed/?term=Dahl RM[Author]&cauthor=true&cauthor_uid=29427907]Dahl RM[/url]4, [url=https://www.ncbi.nlm.nih.gov/pubmed/?term=Mustaquim D[Author]&cauthor=true&cauthor_uid=29427907]Mustaquim D[/url]5, [url=https://www.ncbi.nlm.nih.gov/pubmed/?term=Gerber SI[Author]&cauthor=true&cauthor_uid=29427907]Gerber SI[/url]2, [url=https://www.ncbi.nlm.nih.gov/pubmed/?term=Watson JT[Author]&cauthor=true&cauthor_uid=29427907]Watson JT[/url]2.

Author information


Abstract

BACKGROUND:

Human coronaviruses (HCoVs) -OC43, -229E, -NL63 and -HKU1 cause upper and lower respiratory tract infections. HCoVs are globally distributed and the predominant species may vary by region or year. Prior studies have shown seasonal patterns of HCoV species and annual variation in species prevalence but national circulation patterns in the US have not yet been described.

OBJECTIVES:

To describe circulation patterns of HCoVs -OC43, -229E, -NL63 and -HKU1 in the US.

STUDY DESIGN:

We reviewed real-time reverse transcription polymerase chain reaction (rRT-PCR) test results for HCoV-OC43, -229E, -NL63 and -HKU1 reported to The National Respiratory and Enteric Virus Surveillance System (NREVSS) by U.S. laboratories from July 2014-June 2017. We calculated the total number of tests and percent positive by week. For a subset of HCoV positive submissions with age and sex of the patient available, we tested for differences in age and sex across the four HCoV species using Chi Square and Kruskal Wallace tests.

RESULTS:

117 laboratories reported 854,575 HCoV tests; 2.2% were positive for HCoV-OC43, 1.0% for HCoV-NL63, 0.8% for HCoV-229E, and 0.6% for HCoV-HKU1. The percentage of positive tests peaked during December - March each year. No significant differences in sex were seen across species, although a significant difference in age distribution was noted.

CONCLUSIONS:

Common HCoVs may have annual peaks of circulation in winter months in the US, and individual HCoVs may show variable circulation from year to year. Different HCoV species may be detected more frequently in different age groups. Further years of data are needed to better understand patterns of activity for HCoVs.
Published by Elsevier B.V.

KEYWORDS:

Coronavirus; Epidemiology; Respiratory tract infection; Respiratory virus

PMID: 29427907 DOI: 10.1016/j.jcv.2018.01.019
[Indexed for MEDLINE]


https://www.ncbi.nlm.nih.gov/pubmed/29427907

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Human coronavirus circulation in the United States 2014-2017. Empty Human coronavirus circulation in the United States 2014–2017☆

Post by rocky on Wed 01 Apr 2020, 2:58 am

Journal of Clinical Virology

Volume 101 , April 2018, Pages 52-56


Human coronavirus circulation in the United States 2014–2017
Author links open overlay panelMarie E.Killerby[size=11]ab Holly M.Biggsa AmberHaynesc Rebecca M.Dahld DesireeMustaquime Susan I.Gerbera John T.Watsona
Show more[/size]
https://doi.org/10.1016/j.jcv.2018.01.019 Get rights and content


Highlights



During July 2014–June 2017, 854,575 human coronavirus  tests were reported to NREVSS.

The percent of positive human coronavirus tests peaked during December–March.

Different human coronavirus species predominated in different years.

Human coronavirus OC43  was the most commonly detected species.


Abstract

Background

Human coronaviruses (HCoVs) -OC43, -229E, -NL63 and -HKU1 cause upper and lower respiratory tract infections. HCoVs are globally distributed and the predominant species may vary by region or year. Prior studies have shown seasonal patterns of HCoV species and annual variation in species prevalence but national circulation patterns in the US have not yet been described.

Objectives

To describe circulation patterns of HCoVs -OC43, -229E, -NL63 and -HKU1 in the US.

Study design

We reviewed real-time reverse transcription polymerase chain reaction (rRT-PCR) test results for HCoV-OC43, -229E, -NL63 and -HKU1 reported to The National Respiratory and Enteric Virus Surveillance System (NREVSS) by U.S. laboratories from July 2014–June 2017. We calculated the total number of tests and percent positive by week. For a subset of HCoV positive submissions with age and sex of the patient available, we tested for differences in age and sex across the four HCoV species using Chi Square and Kruskal Wallace tests.

Results

117 laboratories reported 854,575 HCoV tests; 2.2% were positive for HCoV-OC43, 1.0% for HCoV-NL63, 0.8% for HCoV-229E, and 0.6% for HCoV-HKU1. The percentage of positive tests peaked during December – March each year. No significant differences in sex were seen across species, although a significant difference in age distribution was noted.

Conclusions

Common HCoVs may have annual peaks of circulation in winter months in the US, and individual HCoVs may show variable circulation from year to year. Different HCoV species may be detected more frequently in different age groups. Further years of data are needed to better understand patterns of activity for HCoVs.


Keywords

Coronavirus
Epidemiology
Respiratory tract infection
Respiratory virus


1. Background


Human coronaviruses  (HCoVs) HCoV-NL63, HCoV-HKU1, HCoV-229E, and HCoV-OC43 circulate worldwide and cause a range of respiratory symptoms [1 ]. Infections are often asymptomatic or associated with mild to moderate upper respiratory tract  illness in immunocompetent children and adults; HCoVs are considered the second most common cause of the common cold [2 ]. Infections can also result in lower respiratory tract  illness including bronchiolitis  and pneumonia, especially in immunocompromised individuals, infants, and older adults [1 ]. Increased availability of molecular test methods and more frequent testing for multiple respiratory pathogens have allowed for opportunities to characterize circulation patterns of individual HCoVs.

Although HCoVs are globally distributed, the predominant species may vary by region or year [[3][4][5] ]. Previous studies have shown seasonal patterns of HCoV species and annual variation in species prevalence [[3][4][6] ]. However, national circulation patterns across the United States have not been described and few studies have described circulation of all four HCoVs across multiple years [6 ].

2. Objectives


Our objective was to describe laboratory detections of HCoVs -NL63, -HKU1, -229E, and -OC43 in the United States during 2014–2017, using data collected by The National Respiratory and Enteric Virus  Surveillance System (NREVSS) [7 ].

3. Study design


NREVSS is a passive surveillance network established by the U.S. Centers for Disease Control and Prevention (CDC) in the 1980s that collects specimen test results for several respiratory and enteric viruses  from multiple laboratories across the United States [7 ]. NREVSS currently collects data from three different sources: directly from clinical, state, and local laboratories; indirectly from state or local partners on behalf of laboratories within their jurisdictions; and indirectly through the Public Health Laboratory Interoperability Project (PHLIP).

PHLIP is a collaborative partnership between CDC, state and local public health labs (PHLs), and the Association of Public Health Laboratories (APHL) to strengthen the submission of automated specimen-level surveillance laboratory test results directly to CDC [8 ]. Laboratories submitting to NREVSS via PHLIP submit specimen level results for respiratory virus tests along with patient demographics, such as sex and age. The remaining majority of NREVSS participants (i.e. non-PHLIP submitters) submit weekly aggregates of positive detections for the four HCoV species by RT-PCR  along with the aggregate number of RT-PCR HCoV tests performed.

To better understand HCoV circulation in the US, we assessed reports of specimens tested for HCoVs, and submitted to NREVSS during July 1, 2014–June 30, 2017. Reporting laboratories were excluded if they did not report HCoV results at the species level. We summarized the total number of HCoV tests submitted during the study period and calculated the overall percent positive for each HCoV species by week. Test numbers and positive HCoV results were also summarized separately for individual US census regions.

To understand demographics of patients with HCoV detections we further analyzed the subset of NREVSS data reported through PHLIP. We selected reports of specimens tested for all four HCoV species and calculated the percent positive for each HCoV species. We used all PHLIP reports with a single positive HCoV detection to test differences in age distribution among the four HCoV species using the Kruskal Wallis Test . Differences in sex distribution among the four HCoV species were tested using the Chi Square Test . We then summarized viral co-detections for each HCoV species using reports of specimens tested for all four HCoVs and which were also tested for the following viruses: parainfluenza viruses 1–4, respiratory syncytial virus  (RSV), human metapneumovirushuman adenovirus , rhinovirus/enterovirus, influenza A  and influenza B.  Analysis was performed using R version 3.3.1.

4. Results


During July 1, 2014–June 30, 2017, 854,575 HCoV tests were reported by 117 laboratories in 42 states submitting to NREVSS. Overall, 18,804 (2.2%) were positive for HCoV-OC43, 8558 (1.0%) for HCoV-NL63, 7001 (0.8%) for HCoV-229E and 5225 (0.6%) for HCoV-HKU1. The number of HCoV tests submitted to NREVSS per week varied seasonally, with the testing peak occurring each year in winter, generally between December and March (Fig. 1 A). Overall HCoV testing increased during the three years (Fig. 1 A). The percent of HCoV positive tests varied throughout each year, and also peaked each year between December and March. The percent positive varied annually by HCoV species (Fig. 1 B). HCoV-OC43 demonstrated a distinct peak each of the three years, with a less pronounced peak in 2016. HCoV-NL63 and HCoV-HKU1 demonstrated similar patterns to one another; both had a small peak in 2015 and larger peaks in 2016, although only HCoV-NL63 had a small peak in 2017. HCoV-229E showed a slight peak in 2015, no peak in 2016 and a relatively large peak in 2017 (Fig. 1 B). The highest percent positive for any single species was 7.6% of tests positive for HCoV-OC43 in the week beginning December 31, 2016. Across each census region, minimal differences in seasonal and annual patterns of percentage of tests positive for each HCoV species were seen compared to national data (Fig. 2 ). The most notable difference was in the percentage of positive HCoV-OC43 tests during the 2016–2017 season, with the West region showing a peak percent positive of 5.0% and the Midwest region showing a peak percent positive of 12.4%.
Human coronavirus circulation in the United States 2014-2017. 1-s2.0-S1386653218300325-gr1
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Fig. 1. A) The number of tests performed to detect any of the four human coronaviruses  (HCoVs) -OC43, -NL63, -229E, and -HKU1 reported to the National Respiratory and Enteric Viruses  Surveillance System (NREVSS) by week, July 2014–June 2017, B) The percentage of tests positive for HCoVs -OC43, -NL63, -229E, and -HKU1 reported to NREVSS by week, July 2014–June 2017.
Human coronavirus circulation in the United States 2014-2017. 1-s2.0-S1386653218300325-gr2
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Fig. 2. The percentage of tests positive for human coronaviruses  (HCoVs) -OC43, -NL63, -229E, and -HKU1 reported to the National Respiratory and Enteric Viruses  Surveillance System (NREVSS) by week, stratified by US Census Region, July 2014–June 2017.


Data reported to NREVSS through PHLIP was further analyzed to understand sex and age characteristics. During the study period, 20,806 specimens tested for all four HCoVs were submitted via PHLIP from six laboratories. Overall 1569 tests (7.5%) were positive for any HCoV; 852 (4.1%) were positive for HCoV-OC43, 255 (1.2%) for HCoV-NL63, 335 (1.6%) for HCoV-229E and 154 (0.7%) for HCoV-HKU1. The majority of specimens with a single HCoV detection (92.2% of 1543 specimens) included the sex of the patient, and approximately half (50.6%) of all these HCoV detections were reported as male. No significant difference was seen in the sex distribution between the four HCoVs (p = 0.19). Age was available for 1016 (67%) of specimens with a single HCoV detection and the median patient age of these specimens was 23 years (range 0–96 years). The patient age distribution of specimens with a single HCoV detection was significantly different between species (p < 0.01) (Fig. 3 ). The median ages of patients with specimens testing positive for a single HCoV species were as follows: HCoV-OC43, 24 years; HCoV-NL63, 11 years; HCoV-229E, 30 years; and HCoV-HKU1, 19 years. For HCoV-OC43, HCoV-NL63, and HCoV-HKU1 >45% of detections were in children <18 years old (Fig. 3 ). By contrast, 31% of HCoV-229E detections were in children <18 years old (Fig. 3 ).
Human coronavirus circulation in the United States 2014-2017. 1-s2.0-S1386653218300325-gr3
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Fig. 3. Age distribution of human coronaviruses  (HCoVs) -229E, -HKU1, -NL63 and -OC43 positive tests with age available reported to NREVSS via the Public Health Laboratory Interoperability Project (PHLIP), from July 2014–June 2017. Note, specimens with more than one coronavirus  detected were excluded (n = 18).


Among the 1569 HCoV positive detections reported via PHLIP, 1538 (98%) were also tested for parainfluenza viruses 1–4, respiratory syncytial virus  (RSV), human metapneumovirushuman adenovirus , rhinovirus/enterovirus, influenza A  and influenza B.  Among these, 68.6% reported a single HCoV species detection only, 1.7% reported two or more HCoV species, and 30.2% detected another respiratory virus . The most common HCoV co-detections were HCoV-OC43 with HCoV-NL63 (8 specimens, 0.5%), and HCoV-OC43 with HCoV-229E (8 specimens, 0.5%). The most common co-detected non-HCoV viruses were RSV (11% of HCoV positive specimens), rhinovirus/enterovirus (6.6%), and influenza A (5.7%); 51 (3.3%) specimens had ≥2 viral species detected in addition to HCoV. Co-detection patterns were broadly similar among the four HCoVs (Table 1 ).

[size=14]Table 1. Frequency and percentage (in parentheses) of viral co-detections for by individual human coronavirus  (HCoV) detection and all HCoV detections, reported to NREVSS via PHLIP from July 2014–June 2017.


[/size][/size][th][/th][th]HCoV-OC43[/th][th]HCoV-NL63[/th][th]HCoV-229E[/th][th]HCoV-HKU1[/th][th]PIV[/th][th]RSV[/th][th]HMPV[/th][th]HAdV[/th][th]RV/EV[/th][th]Flu A[/th][th]Flu B[/th][th]Any non-HCoV co-detection[/th][th]HCoV-OC43 n = 836[/th][th]HCoV-NL63 n = 253[/th][th]HCoV-229E n = 325[/th][th]HCoV-HKU1 n = 151[/th][th]All HCoVs[/th]
836 (100)8 (1.0)8 (1.0)4 (0.5)28 (3.3)100 (12.0)23 (2.8)54 (6.5)59 (7.1)44 (5.3)10 (1.2)259 (31.0)
8 (3.2)253 (100)3 (1.2)5 (2.0)5 (2.0)26 (10.3)10 (4.0)13 (5.1)19 (7.5)11 (4.3)0 (0.0)74 (29.2)
8 (2.5)3 (0.9)325 (100)0 (0.0)16 (4.9)21 (6.5)9 (2.8)11 (3.4)11 (3.4)27 (8.3)5 (1.5)89 (27.4)
4 (2.6)5 (3.3)0 (0.0)151 (100)5 (3.3)21 (13.9)5 (3.3)10 (6.6)13 (8.6)8 (5.3)2 (1.3)53 (35.1)
836 (54.4)253 (16.4)325 (21.1)151 (9.8)54 (3.5)164 (10.7)47 (3.1)86 (5.6)101 (6.6)87 (5.7)17 (1.1)465 (30.2)
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PIV = parainfluenza virus , RSV = respiratory syncytial virus , HMPV = human metapneumovirus , HAdV = human adenovirus , RV/EV = rhinovirus/enterovirus, Flu A = influenza A , Flu B = influenza B
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5. Discussion


This report is the first to describe the national patterns of circulation of the four common HCoV species in the United States during a multi-year period. During the study period, HCoVs showed a peak prevalence during December– March each year, which coincides with the winter respiratory virus  season [[7][9] ]. HCoV-OC43 was the most commonly detected HCoV with 2.2% of all tests positive. Different HCoV species predominated in different years; HCoV-OC43 appeared to peak annually, while HCoV-NL63, HCoV-HKU1, and HCoV-229E showed more variability, with distinct peaks in one or two of the three years studied. This is consistent with previously published site-specific data indicating that individual species may only demonstrate peak activity every 2–3 years [[10][11] ].

Factors associated with annual differences in activity for HCoV species are currently unknown. Individual HCoV species activity could fluctuate independently, or cross-immunity within or between Alphacoronavirinae (HCoV-229E and HCoV-NL63) and Betacoronavirinae (HCoV-HKU1 and HCoV-OC43) might affect annual activity of the four HCoVs [[4][12] ]. During the study period, HCoV-229E and HCoV-NL63 did not show large contemporaneous peaks of activity, although both showed smaller peaks of activity in 2014–2015. When data was visualized by census region, annual and seasonal patterns were similar to those seen nationally (Fig. 2 ).

The age distribution of patients with reported HCoV infections differed between HCoV species (Fig. 3 ). HCoV-229E detections were more common in adults >18 years old compared to HCoV-HKU1, -NL63, and -OC43. HCoV-229E has previously been reported as disproportionately affecting immunocompromised individuals relative to the other HCoV species [4 ], possibly affecting the median reported age at infection. HCoV-NL63 showed the lowest median age of infection, and has been shown to be associated with croup in young children [13 ], which may lower the average age of infection. Non-HCoV viral co-detections were seen in 30% of specimens positive for HCoV, and 3.3% of specimens had two or more co-detected viral species. The clinical impact of coronaviruses  in co-detections is not fully understood, with prior studies reporting both increased and unchanged morbidity and mortality with respiratory viral co-detections [14 ]. Single infections with HCoVs have been associated with morbidity due to lower and upper respiratory tract  infections [4 ], however Prill et al demonstrated that HCoVs were not found more frequently in children hospitalized for acute respiratory illness and/or fever than asymptomatic controls [15 ].

There were limitations to this report. NREVSS is a passive, voluntary surveillance system, collecting results from specimens submitted to U.S. laboratories. Many HCoV infections are subclinical or mild, and do not require clinical care; therefore these infections are unlikely to require laboratory testing and would not be captured by NREVSS. The relative proportions of HCoV species reported here may not be representative of all HCoV infections. Within NREVSS all reporters of HCoV surveillance data at the species level were included, including those inconsistently reporting over time. This may result in certain laboratories or regions being overrepresented at certain times e.g. during winter, when the majority of respiratory virus tests are conducted.

Data reported to NREVSS through PHLIP represent a smaller subset of six laboratories that also report additional data including sex and age; data reported through PHLIP may not be representative of the entire NREVSS population. The overall percent of HCoV positive tests varied between PHLIP and NREVSS; the percent of HCoV positive tests submitted to NREVSS via PHLIP was 7.5%, vs 4.6% for NREVSS as a whole. This may result from differences in reporting laboratories; reporting through PHLIP is limited to military, state and public health laboratories, whereas data submitted directly to NREVSS through non-PHLIP sources primarily includes clinical laboratories. State and local public health laboratories test for a variety of reasons including surveillance and public health response to outbreaks and clusters of cases, whereas clinical laboratories often test in the course of managing individual cases.

Within the peak in detections noted during December-March, we were not able to define precise seasonal onset and offset periods for any individual HCoV species. Additionally, we assessed HCoV percent positivity over time based on the date of submission of a report to NREVSS rather than the date of specimen collection, and we anticipate that our findings may reflect this slight delay. Finally, aggregate data reported to NREVSS via PHLIP might include multiple specimens from the same patient, potentially impacting the demographic characteristics  of reported cases.

Surveillance of HCoVs is important to determine seasonality  and annual circulation patterns. Continued use of respiratory virus multiplex assay panels could facilitate further definition of HCoV circulation through public health surveillance in the future. Further years of data are needed to better understand patterns of activity for HCoVs, and studies with additional epidemiologic data will be useful to better characterize HCoV burden and spectrum of illness.



https://www.sciencedirect.com/science/article/pii/S1386653218300325
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rocky
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Human coronavirus circulation in the United States 2014-2017. Empty Re: Human coronavirus circulation in the United States 2014-2017.

Post by rocky on Wed 01 Apr 2020, 3:01 am

This is what I heard on  Laura Ingraham 
angle, fox news this morning


also I'm looking for article that 25,000 chinese entered the usa in december 2019


Last edited by rocky on Wed 01 Apr 2020, 3:24 am; edited 1 time in total
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Human coronavirus circulation in the United States 2014-2017. Empty Proclamation on Suspension of Entry as Immigrants and Nonimmigrants of Persons who Pose a Risk of Tr

Post by rocky on Wed 01 Apr 2020, 3:17 am

PROCLAMATIONS

[size=36]Proclamation on Suspension of Entry as Immigrants and Nonimmigrants of Persons who Pose a Risk of Transmitting 2019 Novel Coronavirus[/size]

 HEALTHCARE
 
 Issued on: January 31, 2020












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[size=11]Human coronavirus circulation in the United States 2014-2017. Menu-large ALL NEWS


The United States has confirmed cases of individuals who have a severe acute respiratory illness caused by a novel (new) coronavirus (“2019-nCoV”) (“the virus”) first detected in Wuhan, Hubei Province, People’s Republic of China (“China”).  The virus was discovered in China in December 2019.  As of January 31, 2020, Chinese health officials have reported approximately 10,000 confirmed cases of 2019-nCoV in China, more than the number of confirmed cases of Severe Acute Respiratory Syndrome (SARS) during its 2003 outbreak.  An additional 114 cases have been confirmed across 22 other countries; in several of these cases, the infected individuals had not visited China.  More than 200 people have died from the virus, all in China.
Coronaviruses are a large family of viruses.  Some cause illness in people and others circulate among animals, including camels, cats, and bats.  Animal coronaviruses are capable of evolving to infect people and subsequently spreading through human-to-human transmission.  This occurred with both Middle East Respiratory Syndrome and SARS.  Many of the individuals with the earliest confirmed cases of 2019-nCoV in Wuhan, China had some link to a large seafood and live animal market, suggesting animal-to-human transmission.  Later, a growing number of infected individuals reportedly did not have exposure to animal markets, indicating human-to-human transmission.  Chinese officials now report that sustained human-to-human transmission of the virus is occurring in China.  Manifestations of severe disease have included severe pneumonia, acute respiratory distress syndrome, septic shock, and multi-organ failure.
Neighboring jurisdictions have taken swift action to protect their citizens by closing off travel between their territories and China.  On January 30, 2020, the World Health Organization declared the 2019-nCoV outbreak a public health emergency of international concern.
Outbreaks of novel viral infections among people are always of public health concern, and older adults and people with underlying health conditions may be at increased risk.  Public health experts are still learning about the severity of 2019-nCoV.  An understanding of the key attributes of this novel virus, including its transmission dynamics, incubation period, and severity, is critical to assessing the risk it poses to the American public.  Nonetheless, the Centers for Disease Control and Prevention (CDC) has determined that the virus presents a serious public health threat.
The CDC is closely monitoring the situation in the United States, is conducting enhanced entry screening at 5 United States airports where the majority of travelers from Wuhan arrive, and is enhancing illness response capacity at the 20 ports of entry where CDC medical screening stations are located.  The CDC is also supporting States in conducting contact investigations of confirmed 2019-nCoV cases identified within the United States.  The CDC has confirmed that the virus has spread between two people in the United States, representing the first instance of person-to-person transmission of the virus within the United States.  The CDC, along with state and local health departments, has limited resources and the public health system could be overwhelmed if sustained human-to-human transmission of the virus occurred in the United States.  Sustained human-to-human transmission has the potential to have cascading public health, economic, national security, and societal consequences.
During Fiscal Year 2019, an average of more than 14,000 people traveled to the United States from China each day, via both direct and indirect flights.  The United States Government is unable to effectively evaluate and monitor all of the travelers continuing to arrive from China.  The potential for widespread transmission of the virus by infected individuals seeking to enter the United States threatens the security of our transportation system and infrastructure and the national security.  Given the importance of protecting persons within the United States from the threat of this harmful communicable disease, I have determined that it is in the interests of the United States to take action to restrict and suspend the entry into the United States, as immigrants or nonimmigrants, of all aliens who were physically present within the People’s Republic of China, excluding the Special Administrative Regions of Hong Kong and Macau, during the 14-day period preceding their entry or attempted entry into the United States.  I have also determined that the United States should take all necessary and appropriate measures to facilitate orderly medical screening and, where appropriate, quarantine of persons allowed to enter the United States who may have been exposed to this virus.
NOW, THEREFORE, I, DONALD J. TRUMP, President of the United States, by the authority vested in me by the Constitution and the laws of the United States of America, including sections 212(f) and 215(a) of the Immigration and Nationality Act (INA), 8 U.S.C. 1182(f) and 1185(a), and section 301 of title 3, United States Code, hereby find that the unrestricted entry into the United States of persons described in section 1 of this proclamation would, except as provided for in section 2 of this proclamation, be detrimental to the interests of the United States, and that their entry should be subject to certain restrictions, limitations, and exceptions.  I therefore hereby proclaim the following:
Section 1.  Suspension and Limitation on Entry.   The entry into the United States, as immigrants or nonimmigrants, of all aliens who were physically present within the People’s Republic of China, excluding the Special Administrative Regions of Hong Kong and Macau, during the 14-day period preceding their entry or attempted entry into the United States is hereby suspended and limited subject to section 2 of this proclamation.
Sec2.  Scope of Suspension and Limitation on Entry.
(a)  Section 1 of this proclamation shall not apply to:
(i)     any lawful permanent resident of the United States;
(ii)    any alien who is the spouse of a U.S. citizen or lawful permanent resident;
(iii)   any alien who is the parent or legal guardian of a U.S. citizen or lawful permanent resident, provided that the U.S. citizen or lawful permanent resident is unmarried and under the age of 21;
(iv)    any alien who is the sibling of a U.S. citizen or lawful permanent resident, provided that both are unmarried and under the age of 21;
(v)     any alien who is the child, foster child, or ward of a U.S. citizen or lawful permanent resident, or who is a prospective adoptee seeking to enter the United States pursuant to the IR-4 or IH-4 visa classifications;
(vi)    any alien traveling at the invitation of the United States Government for a purpose related to containment or mitigation of the virus;
(vii)   any alien traveling as a nonimmigrant under section 101(a)(15)(C) or (D) of the INA, 8 U.S.C. 1101(a)(15)(C) or (D), as a crewmember or any alien otherwise traveling to the United States as air or sea crew;
(viii)  any alien seeking entry into or transiting the United States pursuant to an A-1, A-2, C-2, C-3 (as a foreign government official or immediate family member of an official), G-1, G-2, G-3, G-4, NATO-1 through NATO-4, or NATO-6 visa;
(ix)    any alien whose entry would not pose a significant risk of introducing, transmitting, or spreading the virus, as determined by the CDC Director, or his designee;
(x)     any alien whose entry would further important United States law enforcement objectives, as determined by the Secretary of State, the Secretary of Homeland Security, or their respective designees based on a recommendation of the Attorney General or his designee; or
(xi)    any alien whose entry would be in the national interest, as determined by the Secretary of State, the Secretary of Homeland Security, or their designees.
(b)  Nothing in this proclamation shall be construed to affect any individual’s eligibility for asylum, withholding of removal, or protection under the regulations issued pursuant to the legislation implementing the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, consistent with the laws and regulations of the United States.
Sec3.  Implementation and Enforcement.   (a)  The Secretary of State shall implement this proclamation as it applies to visas pursuant to such procedures as the Secretary of State, in consultation with the Secretary of Homeland Security, may establish.  The Secretary of Homeland Security shall implement this proclamation as it applies to the entry of aliens pursuant to such procedures as the Secretary of Homeland Security, in consultation with the Secretary of State, may establish.
(b)  Consistent with applicable law, the Secretary of State, the Secretary of Transportation, and the Secretary of Homeland Security shall ensure that any alien subject to this proclamation does not board an aircraft traveling to the United States.
(c)  The Secretary of Homeland Security may establish standards and procedures to ensure the application and implementation of this proclamation at United States seaports and in between all ports of entry.
(d)  An alien who circumvents the application of this proclamation through fraud, willful misrepresentation of a material fact, or illegal entry shall be a priority for removal by the Department of Homeland Security.
Sec4.  Orderly Medical Screening and Quarantine.   The Secretary of Homeland Security shall take all necessary and appropriate steps to regulate the travel of persons and aircraft to the United States to facilitate the orderly medical screening and, where appropriate, quarantine of persons who enter the United States and who may have been exposed to the virus.  Such steps may include directing air carriers to restrict and regulate the boarding of such passengers on flights to the United States.
Sec5.  Termination.   This proclamation shall remain in effect until terminated by the President.  The Secretary of Health and Human Services shall, as circumstances warrant and no more than 15 days after the date of this order and every 15 days thereafter, recommend that the President continue, modify, or terminate this proclamation.
Sec6.  Effective Date.    This proclamation is effective at 5:00 p.m. eastern standard time on February 2, 2020.
Sec7.  Severability.    It is the policy of the United States to enforce this proclamation to the maximum extent possible to advance the national security, public safety, and foreign policy interests of the United States.  Accordingly:
(a)  if any provision of this proclamation, or the application of any provision to any person or circumstance, is held to be invalid, the remainder of this proclamation and the application of its provisions to any other persons or circumstances shall not be affected thereby; and
(b)  if any provision of this proclamation, or the application of any provision to any person or circumstance, is held to be invalid because of the lack of certain procedural requirements, the relevant executive branch officials shall implement those procedural requirements to conform with existing law and with any applicable court orders.
Sec8.  General Provisions.   (a)  Nothing in this proclamation shall be construed to impair or otherwise affect:
(i)   the authority granted by law to an executive department or agency, or the head thereof; or
(ii)  the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.
(b)  This proclamation shall be implemented consistent with applicable law and subject to the availability of appropriations.
(c)  This proclamation is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.
IN WITNESS WHEREOF, I have hereunto set my hand this thirty-first day of January, in the year of our Lord two thousand twenty, and of the Independence of the United States of America the two hundred and forty-fourth.
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DONALD J. TRUMP



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